COSMETIC SURGERY STARTS A DOWNHILL SPIRAL

Engin Akyurt - Siem Reap/Cambodia - Pixabay

Every once and awhile, if I think a significant number of people might benefit, I take an email and turn it into a CASE STUDY. This one comes from "Sue" (name changed to protect her identity). Be aware that I do not have time to respond to most emails that are not directly inquiring about my POTENTIAL ABILITY (or inability as the case often is) to help with a specific problem.

In 2010 I had a tummy tuck with removal of love handles and hernia. That night I had profuse bleeding and had get 2 transfusions, but worse, my neck was hanging to floor and I couldn't pick it up. A doctor out of that office mentioned "positional whiplash from the anesthesia" (the nurse anesthetist didn't look smart, I should have run). Does this make sense? I'm here eight years later still in lot pain

Because of this I had two cervical fusions, and now have cervical fusion syndrome. I can't look down or walk fast. I literally can't function. I'd just graduated with a professional degree that I haven't been able to use. I'm very mad. My apartment is paid until Oct, then I pray. I would have had great, busy, life helping people. Instead I sit at home bored and in pain. I have trouble shopping for food. I wanted to make a difference and move to the West coast. Like this, I can't move unless the pain lessens so that I'm sure I can work all day without being fired. My family blames me having surgery.

Please tell me what you think happened and what to do now. I have constant pain even though I'm taking dilaudid. I have a burning tongue, when I move I hear bubbles and cracks, I can't stand, I have sweating feet, my shoulders hurt so bad I can hardly wear a bra. My neck weak and the pain now comes to front chest and upper back. I'm afraid another level is broken. The last fusion was C3 to C7. Prior was C4 to C7. No one warned me I would likely have to have more and more fusions. I thought one was it. I want my life back, I need work, I feel useless, and if not for God, no idea how I'll survive past October.

What would you suggest now for treatment? I'm in so much pain that grocery shopping is terrible. My walking is not right. I have myelopathy. All my limbs and head are heavy. I can't look down. Do you have anything to fix that? I feel disabled, horrible, and alone, and I need job. I really need to use my mind. Please answer.

Thanks,Sue

Receiving a steady stream of emails like this one all day long is difficult. It's tough to watch people struggling with problems that no one has any idea what to do with, and that the majority of the medical community has essentially given up on. In this case we have Sue, a young woman, who had a cosmetic surgery and ended up with a strange side effect of anesthesia. How common is this? While her particular issue is quite rare, according to BJA Education (Injury During Anesthesia), varying degrees of peripheral nerve damage occur somewhere between 1 in 250 to 1 in 5,000 surgeries, depending on a wide variety of factors.

The Royal College of Anesthetists (Risks Associated with your Anesthetic Section 10: Nerve Damage Associated with an Operation Under General Anesthetic) said this about nerve damage from anesthesia. "If motor nerves are damaged, there may be weakness or paralysis (loss of movement) of muscles in that area. Rarely, (less than 1 in 10,000 general anaesthetics) nerve damage occurs that is permanent. Permanent damage lasting more than a year, is estimated to be less than 1 in 5,000. Spinal cord damage occurs in less than 1 in 50,000 patients having a general anaesthetic." While rare, you can see that situations like Sue's sometimes happen. And in similar fashion to the way that adverse reactions to drugs are dramatically under-reported (HERE), the same can be said for adverse events associated with surgical procedures.

So, unlike many patients I've seen who were directly screwed up by their plastic surgeries (HERE for instance), Sue's was indirect. Which brings us to her chronic neck problems. Firstly, remember that "WHIPLASH" affects far more women than men (although I have a tough time actually calling this whiplash). Also, when people have issues in their neck they frequently end up with RADICULOPATHY (irritation of the nerves that go into and affect the hands). Myelopathy is significantly worse because it involves the spinal cord. The American Journal of Neuroradiology (Myelopathy) describes it simply as "any neurologic deficit related to the spinal cord." Although the authors mentioned various tumors and CANCER as a common cause of myelopathy, the most common cause is DEGENERATION (bone spurs, calcium deposits, loss of disc height, etc) or HERNIATION. STENOSIS (narrowing of the spinal canal) is a common cause as well.

Although this paragraph is not geared specifically at Sue, since she's already had two decompression surgeries --- the only treatment the medical community deems viable other than palliative care from the BIG FIVE CLASS OF DRUGS --- doctors will undoubtedly try to convince her to have another surgery. Depending on the degree of severity of the myelopathy, many chiros treat people with it in varying ways. Those include CHIROPRACTIC ADJUSTMENTS (these should typically be non-force techniques for individuals with myelopathy) and stretches / exercises (HERE HERE and HERE are studies).

The surgeries for myelopathy has gotten better over the years, particularly when done only one time at only one level. Case in point is a study from a 2003 issue of Neurosurgical Focus (Laminoplasty for the Treatment of Failed Anterior Cervical Spine Surgery) that said "In anterior cervical decompression and fusion (ACDF), because the risks and likelihood of pseudarthrosis increase with the number of treated segments, attempts are typically made to limit the number of treated levels. Thus, postoperative recurrence of myelopathy following ACDF may occur because stenotic levels were not treated or because adjacent segments have degenerated." You don't have to look very far to see that "adjacent degeneration" is a common phenomenon with spinal surgeries --- particularly fusions. Five years ago last month, the Journal of the American Academy of Orthopedic Surgeons (Adjacent Segment Disease Following Cervical Spine Surgery) concluded that.....

"Adjacent segment cervical disease occurs in approximately 3% of patients per year, with an expected incidence of 25% within the first 10 years following fusion. Nonfusion procedures such as anterior diskectomy and posterior foraminotomy do not decrease the rate of adjacent segment disease compared with ACDF. Recently, enthusiasm has developed for artificial disk replacement as a motion-sparing alternative to fusion. To date, however, multiple clinical trials and subsequent follow-up studies have failed to demonstrate significant reduction of adjacent segment disease when artificial disk replacement is performed instead of fusion."

In other words, if you have fusion, you are far more at risk for problems above and below that surgery (adjacent levels). This is much more true for multiple levels or surgeries than for a single level of surgery. The literature (both scientific and non-scientific --- message boards, blogs, articles, etc) abounds with studies and stories of post-surgical difficulties. Knowing all this is great, but nothing I've talked about thus far is going to help Sue get better. We'll get there, but I want to talk about her symptoms a bit more first.

The sweating feet could easily be a sign of SYMPATHETIC DOMINANCE (click the link as I show you some ways to help control it). The inability to look down is because your lower and mid cervical spine (where all neck flexion and extension takes place) has been fused solid. And while peer review is not loaded with studies connecting myelopathy to burning in the tongue, there is ample anecdotal evidence on message boards. The shoulder pain is a common symptom of radiculopathy (pinched or irritated nerves in the neck that run to the hands) as well as myelopathy, increasing the potential for future surgeries due to a phenomenon we mentioned a moment ago --- Adjacent Degeneration Syndrome (the levels above and below the fusion wear out rapidly). And as for the "bubble sounds and creaking and popping," this is known as 'creep' and is a sign of degenerative changes (HERE), all of which are signs of failed cervical fusion syndrome. Here is what WebMD says about failed neck fusion surgery.

"When symptoms such as numbness or weakness in the arm suggest that a neck problem is causing a pinched nerve (radiculopathy), surgery may help you feel better faster. But it's not clear that surgery is any better than nonsurgical treatment in the long run. And research also suggests that a complex surgery that includes fusion is not better than a simpler surgery to take the pressure off the nerve."

Three years ago this month, the HSS Journal carried a study (Revision Surgery for Failed Cervical Spine Reconstruction) by researchers from Philly's Thomas Jefferson University and Hospital.

"As the number of cervical spine procedures performed continues to increase, the need for revision surgery is also likely to increase. Revision rates for surgery on the cervical spine can be high, and vary by the type of procedure performed. Adjacent segment disease (ASD) is common after cervical spine surgery. After anterior cervical arthrodesis, the rate is approximately 2.9% per year, and after a second cervical fusion, the incidence of ASD is up to 25%."

Although you are between a rock and a hard place Sue, there is quite likely room for improvement --- possibly significant improvement. The very first thing that someone in your situation needs to do is to reduce your level of SYSTEMIC INFLAMMATION to a crawl (I always suggest doing this both PRE- AND POST-SURGERY as well). Beyond that, there are several modalities or treatments that may have good effects (LASERS {probably needs to be a Class IV}, PEMF, TISSUE REMODELING, ACUPUNCTURE, etc, etc, etc). Once the surgery is healed, gentle traction is sometimes beneficial, not so much for the fused area(s), but for the areas "adjacent" the fusion. And although much of it will not pertain specifically to you, I actually created a generic template for dealing with systemic inflammation (HERE). As is always the case with someone in severe situations, consult with your doctor before undertaking anything that could prove detrimental.

For the record, it always amazes me how many studies there are, showing that for a wide variety of musculoskeletal issues (SPINAL DEGENERATION and DISC HERNIATION are two of the biggies), there is little correlation between imaging results and the symptoms or degree of pain. This should provide some hope because it indicates that inflammation is playing a huge role. In other words, reduce inflammation and you likely reduce your symptoms.

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Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).